This is a continuation of a project to develop psychometrically matched English and Spanish language neuropsychological assessment scales for use with older persons. During previous grant cycles, item response theory (IRT) methods were used to develop the Spanish and English Neuropsychological Assessment Scales (SENAS), a 13-scale test battery with psychometric matching between and within language groups. The proposed continuation has three primary goals: 1) to expand the domains assessed by this battery, 2) to expand the normative base and applicability to additional ethnic groups, and 3) to evaluate construct validity for measuring dementia and early, pre-dementia cognitive impairment, and for measuring and predicting cognitive decline in individuals with mild cognitive impairment. A central focus of the proposed continuation will be on identifying pre-dementia cognitive impairment and predicting cognitive decline and development of dementia in three ethnic groups: Hispanics, African Americans, and Caucasians. The carefully constructed, psychometrically matched scales will allow for sensitive characterization of the degree and pattern of baseline cognitive and functional impairment in these groups and of the degree and pattern of cognitive and functional decline. Specific Aims will be to: 1) Use IRT methods developed in this project to create brief and practical measures for assessing executive function and day-to-day independent function, 2) Evaluate psychometric properties of the SENAS in African Americans, Hispanics, and Caucasians and expand norms for these groups, 3) Identify demographic and cultural variables that contribute to ethnic group differences in test scores, 4) Evaluate the validity of the SENAS for measuring clinically meaningful cognitive impairment in the three ethnic groups using cross-sectional and longitudinal data, and 5) Identify baseline predictors of cognitive and functional decline in CIND cases from the three ethnic groups. African American, Hispanic, and Caucasian patients attending general medical clinics will be screened with the SENAS. Patients with CIND and selected normals and demented patients will be clinically evaluated and followed longitudinally to assess sensitivity of the SENAS to early cognitive decline.